Generality
The compartment syndrome is an affection of a certain clinical importance, which appears following bleeding or edema and is characterized by an increase in pressure inside a so-called muscular compartment.
Some of the main symptoms of the compartment syndrome are: pain, tingling, muscle cramps, muscle tension and numbness.
The treatment varies depending on the type of compartment syndrome: in the presence of the acute form, it is necessary to intervene surgically; in the presence of the chronic form, instead, it is still possible to resort to conservative therapies.
What is the compartment syndrome?
The compartment syndrome is a very serious condition, whose presence is characterized by an increase in pressure inside a so-called muscular compartment .
In anatomy, the groups of muscles of the lower limbs and upper limbs take the name of muscular compartments, enclosed, together with the neighboring blood vessels and nerves, by a strong tissue membrane, known simply as a fascia . The bands that make up the muscular compartments are not very elastic and this represents an obstacle to the expansion of the muscular compartments themselves.
Causes
The compartment syndrome arises as a result of bleeding or edema, which takes place inside a muscle compartment.
The occurrence of hemorrhage or edema in a compartment produces an abnormal increase in the pressure inside the compartment itself, as the fascia does not allow for expansion.
The aforementioned pressure rise compresses the blood vessels of the affected compartment and this affects the normal blood flow. If left untreated, impaired blood flow is a cause of permanent damage to the muscular and nerve structures of the compartment involved.
In fact, as most people know, blood contains the oxygen that is needed by the tissues and organs of the human body to survive and function at its best. Without the right amount of blood, tissues and organs slowly develop necrosis.
Necrosis of a tissue or organ means their death.
In the case of the compartment syndrome, necrosis of the anatomical structures of a muscular compartment may make it necessary to amputate the affected limb.
The areas of the body most prone to compartmental syndrome are: hands, feet, thighs and arms.
TYPES OF COMPARTMENTAL SYNDROME
The doctors distinguished the compartmental syndrome in two main types: the acute compartment syndrome and the chronic compartment syndrome .
The acute compartment syndrome is distinguished from the chronic compartment syndrome by the triggering causes and the speed of onset of symptoms.
ACUTE COMPARTMENTAL SYNDROME
The acute compartment syndrome is the most common type of compartment syndrome.
The possible causes of acute compartment syndrome include:
- Limb fractures;
- Trauma / injury from crushing of the limbs;
- Strong trauma to the muscles, which can cause injury (muscle tear). Severe muscle injuries can cause more or less conspicuous bleeding;
- The application of a plaster cast or a very tight bandage, when an edema is forming. In these situations, the plaster cast or the very tight bandage are used as a band of the muscular compartment;
- Severe burns to the damage of the limbs;
- Surgical operations aimed at repairing blood vessels in the lower or upper limbs. In such circumstances, the acute compartment syndrome is a complication of the surgical procedure;
- The vigorous physical efforts, in particular those that involve an eccentric movement of the muscles;
- Abuse of alcohol or some pharmacological substances.
The acute compartment syndrome appears suddenly (takes a few hours) and, from a clinical point of view, represents a medical emergency that requires immediate intervention.
CHRONIC COMPARTMENTAL SYNDROME
The chronic compartment syndrome is a condition that is gradually established, almost always as a result of a physical activity or a motor gesture repeated a large number of times, over a long period of time.
From the clinical point of view, it is a less serious problem than the acute compartment syndrome and concerns, above all, people who regularly practice sports such as running, cycling or swimming.
Epidemiology
Acute compartment syndrome can affect people of any age.
The chronic compartment syndrome, on the other hand, particularly concerns adults under the age of 40, although - it should be pointed out - it can potentially arise at any age.
Symptoms and Complications
To learn more: Symptoms Compartmental Syndrome
The symptoms of the acute compartment syndrome are different from the symptoms of the chronic compartment syndrome.
The typical symptomatology of the acute form includes:
- Intense pain in the muscles of the affected muscle compartment. Very often, this pain becomes more acute when the patient tends to lengthen it. Moreover, it does not improve either with the elevation of the limb to which the muscle (s) belongs, or with the intake of pain medication;
- Sense of tension in the muscles of the affected muscle compartment;
- Tingling or burning sensation in the skin area that covers the affected muscle compartment;
The characteristic clinical manifestations of the chronic form, instead, consist of:
- Pain and / or cramps during physical activity or motor gestures that triggered the compartment syndrome. Generally, pain and cramps disappear a few tens of minutes after the subject has stopped working.
It is good to point out that continuing in the activity or in the motor gestures that cause pain and cramps does nothing but further worsen the situation;
- Sense of numbness in the muscular compartment involved;
- Presence of a swelling at the level of the affected muscles;
- Difficulty moving the affected limb .
COMPLICATIONS OF THE ACUTE COMPARTMENTAL SYNDROME
At an advanced stage, the acute compartment syndrome may be characterized by the presence of numbness in the affected muscle compartment and paralysis . These two complications are generally a sign of permanent damage to the anatomical structures that make up the affected muscle compartment.
As stated, the acute compartment syndrome is a medical emergency, the failure to do so promptly may make amputation of the affected limb or limbs indispensable.
COMPLICATIONS OF THE CHRONIC COMPARTMENTAL SYNDROME
Chronic compartment syndrome is not a medical emergency.
However, it should be pointed out that the lack of rest of the affected muscle compartment can cause permanent damage to the latter. This damage can affect not only the muscles of the compartment, but also the nervous structures or blood vessels.
Diagnosis
In general, the diagnostic procedure that leads to the identification of the compartmental syndrome includes the physical examination, the anamnesis and, sometimes, the measurement of the pressure inside the muscular compartment suspected to be the cause of the symptomatology.
The use of an examination such as X-ray radiography, for example, occurs only to exclude conditions from the similar symptom picture (differential diagnosis).
OBJECTIVE AND ANAMNESIS EXAMINATION
The physical examination is the set of diagnostic maneuvers, carried out by the doctor, to verify the presence or absence, in the patient, of signs indicative of an abnormal condition.
For example, in the case of the compartment syndrome, some typical diagnostic maneuvers are:
- The compression of the painful area. This allows us to understand the severity of the pain;
- The movement of the limb that the patient complains of painful. This allows us to understand which gesture causes pain.
The anamnesis, on the other hand, is the collection and critical study of symptoms and facts of medical interest, reported by the patient or his family members (NB: family members are involved, above all, when the patient is small).
MEASUREMENT OF PRESSURE
To quantify the pressure of a muscle compartment, doctors use a pressure meter, which they connect to the area of interest by means of a special needle.
In general, the assessment of the compartmental pressure involves the performance of two measurements: one during a physical activity or a motor gesture involving the painful limb and one at the end of such activity or gesture.
Treatment
The goal of the treatment of the compartment syndrome is to reduce the pressure inside the muscular compartment, in such a way as to restore the blood flow inside the latter and avoid tissue necrosis.
The therapy envisaged in the case of acute compartment syndrome presents some differences from the therapy envisaged in the case of chronic compartment syndrome. In the next two sub-chapters, readers will have the chance to realize what the differences are.
THERAPY OF ACUTE COMPARTMENTAL SYNDROME
In the case of acute compartment syndrome, there is only one therapeutic choice: fasciotomy surgery.
Fasciotomy is an emergency procedure, which generally takes place in a hospital setting and during which the surgeon cuts into the fascia of the affected muscular compartment, in order to reduce the compartmental pressure.
The closure of the incision occurs not before 48-72 hours have elapsed: this is the minimum time necessary for the tissues of the muscular compartment to return to normal.
An early closure of the incision may coincide with the reappearance of the symptomatology.
Sometimes, fasciotomy requires the execution of a skin transplant, to better close the intervention area.
Note : in cases of acute compartment syndrome following the presence of a plaster cast or a too tight bandage, the therapeutic solution is to remove the aforementioned plaster cast or the aforementioned bandage too tightly.
THERAPY OF THE CHRONIC COMPARTMENTAL SYNDROME
The first-line treatment of the chronic compartment syndrome is conservative (or non-surgical). Conservative therapy of chronic compartment syndrome includes:
- A period of rest . The rest of the affected muscles is essential for achieving healing and to avoid the appearance of complications;
- Physiotherapy exercises for stretching the muscles of the affected muscular compartment. In general, the practice of muscle stretching must take place a few days after the resting phase has begun;
- The administration of non-steroidal anti-inflammatory drugs, ie NSAIDs ;
- Elevation of the affected limb ;
- Applying ice on the painful area at least 4-5 times a day. Ice packs have an incredible anti-inflammatory power. Each pack must have a minimum duration of 15 minutes and must not exceed 20 minutes.
If these remedies are ineffective and the symptomatology remains, the only therapeutic solution that can be adopted consists in the fasciotomy surgery.
People who practice sports regularly and have suffered from chronic compartment syndrome in the past may develop the same condition again (recurrence).
To reduce the risks of a recurrence, doctors advise to carry out, in the first period following the recovery, low-impact activities for the limbs previously affected by the compartment syndrome.
Prognosis
The prognosis in the case of acute compartment syndrome depends on the timeliness of the treatment: as stated, in fact, a delay in therapy has a high probability of causing unpleasant consequences.
As regards, instead, the chronic compartment syndrome, the prognosis of the latter depends on the attention that the patient places on treatments: in these situations, in fact, adhering scrupulously to the therapies prescribed by the doctor allows to achieve healing with excellent results and without complicating the compartment syndrome.
